Where were you born? AirmontVA
present occupation - farm laborer
by whom employed? - James Reed
where employed? Hughesville VA
Have you a father , mother, wife, child under 13 or a sister or a brother under
12 solely dependent on you for support? (specify which) wife & child

Married or single - married
race - Negro

X his mark

#12

Carl W JACKSON
age - 29
Home address - PurcellvilleVA
d.o.b. May 15 1888
Where were you born? PaxsonVA
present occupation? Farm Laborer
by whom employed? F. P. Wilson
where employed? Purcellville VA
Married or single - Married
Race Af (scratched out) Negro
Do you claim exemption? Support of wife & children

Carl W Jackson (signature)

Percy Smith JACKSON
age - 21
Home address - Purcellville Virginia
d.o.b. Aug 29 1895
where were you born? LincolnVirginia
present occupation - barber
By whom employed? - McMullin (?)
where employed? Washington DC
Have you a father , mother, wife, child under 13 or a sister or a brother under
12 solely dependent on you for support? (specify which) none
married or single? married
Race - African
military service - none